Thursday, December 29, 2011

In January I began working with the ONC S&I Framework on the Consolidated CDA Guide. I was a co-chair of the Documentation workgroup. The Consolidated Guide was published in December 2011 and I am listed as a co-editor. This IG should be one of the base standards for Meaningful Use Stage 2, and I am honored to have contributed, however slightly, to this effort.

I attended the two ONC S&I Framework Face to Face Meetings in Washington, DC.

I changed jobs in May. I am now a Healthcare Solutions Architect for Covisint.

I worked on a state-wide HIE project, HealthShare Montana. I also work on a Michigan based ACO. I have worked on some internal projects, and will be leading an effort to deploy a terminology service to translate local terminology to standard codes before we store this data. I am also leading an effort to deploy messaging implementation guides and computable artifacts to simplify our process for on-boarding new trading partners.

I am company "standards guy", so I participate in the ONC S&I Framework, HL7, IHE and a few other initiatives.

I decided to become more sociable this year, so I joined twitter (@PeterNGilbert) and facebook.

I was recognized as one of the top contributers to the HIT Social Media conversation (#HITsm).

Tuesday, December 20, 2011

I am honored to be on this list, but I feel a bit like Groucho Marx: "I wouldn't join any club that would have me as a member." :-)

The HITsm tweet chats are an interesting place where a bunch of us that are passionate about using Health Information Technology (HIT) to improve patient care get together to exchange ideas. The chats will resume on Fridays at noon eastern in 2012.

Wednesday, December 14, 2011

Up to now, my company has performed Terminology Management using translate tables in each application. This kind of sort of works, but is cumbersome and prone to error. DocSite has a translate table for each practice, so the code mapping needs to be done over for each practice. Mirth, our CDR, has translate tables for each data source, and so the crossmaps have to be set up for each data source. Also, Mirth will not perform Standard-to-Standard code mapping, so if the code comes in in CPT, Mirth will not translate it to LOINC, for example.

I have a new project coming up where we will have perform code translation as the messages pass through our interface engine, because we will be recieving messages from trading partners (hospitals and clinics) and delivering them to a state-wide Health Information Exchange (HIE).

So, we will use Apelon's Distributed Terminology Service (DTS) and will work with Apelon to create cross maps from local lab codes to LOINC. We will then call DTS from within our interface engine to translate the codes before sending them to the HIE's component systems.

We will also use DTS to perform code set validation. For example, we will have the engine call DTS to ensure that we are actually getting a LOINC code in the field that we are expecting to receive a LOINC code.

I've done code mapping at a couple of previous jobs, so this is a process that I am familiar with. This will be Covisint's first foray into this technology, so it should be fun.

The other thing that should be fascinating is that we will be on-boarding approximately one hundred hospitals and approximately one thousand physician offices for this project. I should be very busy.

I decided to attend the Workgroup leads meeting that started
at 3pm on Monday, even though my workgroup was not meeting. The two CDA related
workgroups do their face to face meeting during the HL7 Work Group meetings,
and so do not attend the ONC Face to Face. The corporate travel system put me
on a flight that departed Detroit at 6am, which meant that I left the house
before 4am. My brother Rob came out to watch my dog, Sonny, while I was out,
which was very nice of him. The flights were uneventful and I made it to the
hotel at about 1pm.

The work group leads meeting was interesting. There were
many folks that I know through HL7 in the room and it was nice to say hello to
them. I met with the Transitions of Care work group leads because the CDA
workgroups are part of ToC. Doug Fridsma stopped in at about 5:30 pm and thanked
us for our efforts. He gave an entertaining speech about his goals for the
initiative.

I went to dinner with the ToC workgroup leads. I am not a
huge fish fan, but the shrimp were fine.

The first full day of the conference began with greeting
more colleagues that I had not seen in a while. One friend had some good news
concerning a project in his state. Two colleagues from my company were also
attending, so we divided up the workgroups so that we had some coverage in most
of them.

The following groups were meeting:

Transitions of Care

Laboratory Results Interface

Provider Directory

Data Segmentation

Query Health

Electronic Submission of Medical Data (esMD)

The last three groups are relatively new. I attended the
Provider Directory meeting in Q1. We are implementing Provider Directory
support for a customer that could not wait until the PD workgroup finalized its
implementation guidance. We took our best guess at some things and know that we
will have to make some changes once the PD workgroup publishes its final
recommendations. My two work colleagues
attended the LRI, Query Health and ToC sessions.

I enjoyed a cigar outside during our lunch break.

I switched to the Data Segmentation workgroup for Q2 through
Q4. This is a new initiative and I have sat through the introductory material
that they presented in Q1 several times. This is an interesting initiative that
focuses on implementing patient privacy preferences in EHRs. The initial focus
in on restricting access to Substance Abuse (42CFR Part 2) and Self Pay
information. We do not implement this well, so I hope to be able to learn from
this initiative. We have several state-wide Health Information Exchange
projects in production as well as several Beacon Initiatives and ACOs, so we
can actually implement this in real world settings and provide feedback on what
works well and what does not. We considered initial User Stories, and it was interesting
to have experts on the regulations in the room providing feedback.

At the end of the day, many of us gathered in the hotel bar
for some refreshment. Doug Fridsma stopped by and chatted with most of us. He
explained his vision of moving from Templated CDA to Green CDA to support the
PCAST vision of a Universal Exchange Language for healthcare. I blogged about
this over the summer, but it was nice to see that I did understand it.

On day two, I met with the Data Segmentation group during
the morning. We reviewed the changes that we had made to the User Stories based
on yesterday’s feedback. Then folks in the room gave short presentations on how
they might be able to assist in implementing the initiative. Since we have
operational exchanges, I think we will be able to implement some of this fairly
quickly.

I attended a presentation on the Model Driven Health Tools
(MDHT) and the upcoming S&I Framework Repository during lunch. I’ve worked
with MDHT since early in the year as part of the CDA IG consolidation project.
It was nice to finally meet the principal author if MDHT in person after
countless hours on teleconferences. It turns out that he lives in Montana and
works with one of the provider groups that will be joining HealthShare Montana,
which is a state-wide HIE that I am the architect of. It is a small world. The
repository demo was interesting, and I look forward to actually seeing it once
it goes live.

I met with the Provider Directory group in Q3. They are
finalizing implementation guidance for PDs. We implemented IHE’s Healthcare
Provider Directory (HPD) support into our ProviderLink product. That should be
placed in to production next month. We’ll be listed as a pilot implementation
by the initiative.

I left the hotel at about 4pm to get to the airport for my
flight back to Detroit. It was raining pretty hard as we left DC. We were delayed slightly getting in to Atlanta, but I had plenty of time before my flight to Detroit. We were actually delayed in leaving Atlanta because our plane did not arrive on time. The flight back to Detroit was uneventful, and I was home shortly after 1am. It was a long day.

When I got to the office, I attended a meeting and
discovered that we will actually be implementing esMD for a customer.

The ONC S&I Framework loves implementers. None of this
stuff is any good until we get it out into the real world and make it work.

Friday, September 30, 2011

In addition to the usual missing codes, units, etc., it looks like they
tried to place the observation in the procedure reason. So I read this
as we performed this unknown procedure from CPT-4 because we got a
result for an improperly coded creatinine random urine test. I suspect
that the procedure entry was used instead of the result observation
entry, and that they really want to be reporting the urine test result. At least, that's what the narrative block seems to indicate.

This describes the problem. Diagnosis/Problem List is broadly
defined as a series of brief statements that catalog a patients medical,
nursing, dental, social, preventative and psychiatric events and issues that
are relevant to that patients healthcare (e.g., signs, symptoms, and defined
conditions)

Version

20081203

Type

Extensional

Binding

Dynamic

Status

Active

Effective Date

Unknown

Expiration Date

N/A

Creation Date

Unknown

Revision Date

20090331

Code System Name

SNOMED CT

Code System Source

National Library of Medicine UMLS

What they are saying here is that patient has a problem, Acute Bronchitis. They coded it internally using ICD9. But, they don't know the SNOMED-CT code for this concept. They need to provide the SNOMED-CT code for this, which is 10509002.

I wonder if I am the only one that works with vendors that don't get it?

Saturday, September 10, 2011

Moosejaw will be playing on Monday nights, this year. The league has four teams and five goalies. They have a goalie schedule and rotation. I will not play every week. I will also play for each of the other teams, once. It will be confusing. We're playing at the Arctic Pond. We played there once before in a different league.

I begin playing with the Wednesday drop-in group this week. I've played with this group of guys for many years. For a while, most of the best players would end up on one team. They beat me like a rented mule. I finally got fed up and played against them every week. When you are the first goalie on the ice, you get to pick the goal that you will play in. I got to the point where I was beating them regularly, and they asked why I never played for them. I told them that I wanted to face the tougher shots.

Last year, they started drafting teams each night, so I never knew who would be shooting at me.

Saturday, August 27, 2011

Healthcare IT is different from other IT in that our customers typically operate 24/7. Thus, our maintenance windows are usually in the wee hours of the morning. You cannot work on healthcare IT any other time.

I've been involved in these early morning sessions for eight years. In my new role as architect, I don't have any real work to do. But, old habits die hard. We performed a maintenance change to a customer's Master Patient Index (MPI) earlier this week. We were able to start that process shortly after 9pm, which is when the last clinic closed. I joined the bridge line and watched the webex as the team worked through the process. I recorded start and stop times for each of the steps in the process and produced a summary for leadership. Even though I wasn't actually at the keyboard doing the work, I felt that just being there and contributing one or two suggestions showed the team that I was part of the team.

This weekend, we are upgrading one of my sites and activating another. The window to perform this work begins at midnight on Sunday morning. I'll try to dial in and listen to progress. I work with a great team, so they will be successful.

I attended the first ONC S&I Framework Face to Face Meeting in DC back in June. I'm not sure that I will get to go to this one, but I will put in the request. I am one of the team leads for the CDA Implementation Guide Documentation Work Group.

Our next S&I Framework is just around the corner.

Make sure you mark your calendars so you don't miss these important working sessions.